Every two months, one of Eva Boniface's three children gets sick with malaria despite using mosquito nets. She is forced to spend extra money on medication and food when her 9, 6 and 4 year olds get sick.
Ipuri resident, Tabora City says malaria remains an important issue in her area due to inadequate community education on proper use of treated mosquito nets, lack of proper drainage and high cost of malaria prevention and treatment.
“Malaria treatment is free for children, but some medications like anti-nausea drugs need to be purchased. What's more, sick children are often fussy with food, so they need to satisfy them beyond their budget,” she said.
Eva added that hospitals may be forced to buy it from the pharmacy because they run out of malaria medication and can't wait for the hospital's inventory to be restocked.
Eva's story is one of many in Tanzania, and despite great progress in reducing infections nationwide, malaria remains a persistent threat in some regions.
According to the World Health Organization (WHO), the prevalence of malaria has dropped from 14% in 2015 to 8.1% in 2022, but the disease continues to affect several regions, with Tanzania still in four countries.
Additionally, malaria is the leading cause of death in children, with 260,000 deaths per year in sub-Saharan Africa.
In Tanzania, infections vary widely from region to region, ranging from 1% in the highlands of Arusha to 15% in the south zone and up to 23% in the lake and west zones. According to Tanzania's Demographic Survey (DHS) 2022, regions such as Tabola, Kagera and Katabi still face high infection rates, pose a major challenge to their goal of eliminating malaria by 2030.
Environmental factors
Geographical factors and climate change have exacerbated mosquito breeding sites in these regions, making malaria management efforts even more challenging.
For example, in Igunga district in the Tabora region, abandoned water ponds become mosquito breeding grounds, contributing to high malaria charges.
Additionally, lack of funding from many local councils regarding malaria prevention and treatment, weak enforcement of public health regulations, and lack of community awareness regarding the proper use of treated mosquito nets.
Josephat Kawambwa, a 36-year-old resident of Kashenge village in Bukova district of the Kagera region, knows this well. He first got sick last March and after diagnosis and treatment with four days of artemisinin-based combination therapy (ALU), he was sick again just two weeks later.
“I had headaches, vomiting and dizziness. I went to the district hospital, where I found out there were three malaria parasites. I was already taking medication, so I prescribed an injection.
This time he contacted the brothers of Dar es Salaam. Dar es Salaam sent money for a trip to receive treatment at Temeke district hospital in the Dar es Salaam region.
The results showed that he had two malaria parasites. My doctor prescribed the same ALU medication as before. After completing the dose, he returned to the hospital for examination and was declared free of malaria.
Kawambwa recognized that the lack of environment and appropriate malaria precautions is a key factor in the recurrence of malaria.
“I gave me a free mosquito net from the district council, but it didn't fit my bed so I used it to make a chicken coop. In Bukova, I didn't use mosquito nets or sprayed with insecticides.
Kawambwa's experience highlights the need for a better mosquito net for improved bed sizes, community-driven malaria control measures, in other parts of Tanzania, where malaria infection rates are high, like Dar Es Salaam.
Mariam Salehe of Dar es Salaam, a resident of Ilala, has acknowledged the government's efforts to combat malaria in the city. These include eradicating mosquito breeding sites, education on people's prevention, and distributing mosquito nets annually to children through schools.
“In the past three years, my family, including my two children and my husband, have not suffered from malaria. It's not that there are no mosquitoes, but I've taken precautions. Before I head out in the morning, I sprayed some pesticides and when I returned in the evening, the mosquitoes were already dead.
Government efforts
As a result of government efforts, malaria infection rates fell from 50-60% in the 1990s to 8% in 2022, according to the National Bureau of Statistics (NBS). Regions such as Dar Es Salaam, Dodoma, Iringa and Mwanza have achieved a significant 1% decrease in infection rates.
Dr. Rashid Mfaume, director of health services, social welfare and nutrition for the Presidential Administration, Regional Government and Local Government (Tamisemi), says special budgets have been allocated to purchase pesticides in expensive areas in advanced regions such as Katavi, Tabola and Kagela and implement control measures.
Progress and future planning
In fiscal year 2024/2025, the government allocated 100 million TZ for purchases of larvae and purchased 1 billion for spraying. The initiatives include distributing free mosquito nets to children and pregnant women, environmental hygiene campaigns, and the use of biological larvae.
Preventive efforts
Dr. Lazarus notes that while prevention and treatment strategies contribute to advancement, continuous efforts, including vaccinations, are important. He said the government is stepping up its malaria prevention and treatment efforts by strengthening local industries such as Tanzania biotechnology products in the coastal region. For fiscal year 2024/2025, 1 billion/- has been allocated to purchase larval agents from Kibaha's factory. Additionally, 1bn/- is assigned to purchase a spray pump.
Dr. Lazarus emphasized the importance of pre-treatment community education and proper diagnosis.
“The government will also continue to provide patients with free malaria treatment and encourage citizens to get tested before using the medication. As not all fever is malaria, we recommend that you test the dosage and ensure it is completed to prevent drug resistance,” he said.
Tanzania has made great strides, but continued investment in prevention, public education and new medical interventions will approach its goal of eliminating malaria by 2030.
This article was created as part of the Aftershocks Data Fellowship (22-23) and was supported by the African Women's Journalism Project (AWJP) in a partnership with the One Campaign and International Journalist Centre (ICFJ).
